A Ruptured Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula: A Case Report and Literature Review
Korean J Helicobacter Up Gastrointest Res 2018;18(2):135-141
Published online June 10, 2018
© 2018 Korean College of Helicobacter and Upper Gastrointestinal Research.

Dong Hwi Kim1, Tae Ho Kim1, Chang Whan Kim1, Jae Hyuck Chang1, Sok Won Han1, Jae Kwang Kim1, Seung Hwan Lee1, Jeana Kim2

Departments of Internal Medicine1 and Hospital Pathology2, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
Correspondence to: Tae Ho Kim
Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea
Tel: +82-32-340-7017, Fax: +82-32-340-7227, E-mail: drkimtaeho@gmail.com
ORCID: https://orcid.org/0000-0003-2015-5176
Received February 6, 2018; Revised March 27, 2018; Accepted March 27, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Pseudoaneurysms of the cystic artery and cholecystoduodenal fistula formation are rare complications of cholecystitis and either may result from an inflammatory process in the abdomen. A 68-year-old man admitted with acute cholecystitis subsequently developed massive upper gastrointestinal (GI) bleeding. Abdominal computed tomography showed acute calculous cholecystitis and hemobilia secondary to bleeding from the cystic artery. Angiography suggested a ruptured pseudoaneurysm of the cystic artery. Upper GI endoscopy showed a deep active ulcer with an opening that was suspected to be that of a fistula at the duodenal bulb. The patient was managed successfully with multimodality treatment that included embolization followed by elective laparoscopic cholecystectomy. Presently, there is no clear consensus regarding the clinical management of this disease. We have been able to confirm various clinical features, diagnoses, and treatments of this disease through a literature review. A multidisciplinary approach through interagency/interdepartmental collaboration is necessary for better management of this disease.
Keywords : Angiography; Cholecystoduodenal fistula; Pseudoaneurysm


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